Soft Tissue Infections Flashcards
Identify
sporothrix schenckii
rose gardeners disease
infection of the dermis and subcutaneous tissue
Cellulitis
superficial skin infection involving the upper dermis with clear
demarcation between involved and uninvolved skin with prominent lymphatic involvement
Erysipelas
formed by multiple interconnecting furuncles that drain through several openings in the skin
Carbuncles
single, deep nodules involving the hair follicle that are
often suppurative
Furuncles
collections of pus within the dermis and deeper skin tissues, potentially involving the subcutaneous tissues
Skin abscesses
microbial triggered necrosis involving any of the soft tissue layers including the dermis, subcutaneous tissues, fascia, and muscle
Necrotizing soft tissue infections
True or false
General Risk Factors for Cellulitis and Erysipelas include: Hypogammaglobulinemia
Obesity
Chronic renal disease
Cirrhosis
True
Fish tank exposure is risk for what organism?
Mycobacterium marinum
hot tub exposure is risk for?
Pseudomonas aeruginosa
Salt water lacerations
Vibrio vulnificus
Vibrio parahaemolyticus
Fresh water lacerations
Aeromonas hydrophila
cirrhosis is risk factor for what org.?
Vibrio vulnificus
Vibrio parahaemolyticus
Gram-negative bacteria
Nonimmunized children and adults
Streptococcus pneumoniae and
Haemophilus influenzae
injection drug use is risk for
Pseudomonas aeruginosa
Contact sports
MRSA
Hemodialysis risk for
MRSA
causative agent in purulent cellulitis
MRSA
For nonpurulent cellulitis causative agent
β-hemolytic streptococcal
What is impairment of lymphatic drainage, permanent swelling, dermal fibrosis, and epidermal
thickening or chronic changes due to recurrent cellulitis
elephantiasis nostra
True or false
Complete involvement of the ear is the “Milian ear sign” and is a distinguishing feature of erysipelas because the ear does not contain deeper dermis tissue typically involved in cellulitis
True
Lymphatic inflammatory change in erysipelas
toxic striations
True or false
wound culture is recommend when the decision has been made to place the patient on antibiotics for purulent cellulitis
True
POCUS is useful in cellulitis to
exclude occult abscess
Doppler studies may be indicated in cellulitis to
distinguish lower extremity deep venous thrombosis from
cellulitis
most important diagnosis to exclude is
necrotizing soft tissue infection
Differentiate Necrotizing soft tissue infection vs cellulitis
Rapid progression; triad of severe pain, swelling, and
fever; pain out of proportion to exam; severe toxicity;
hemorrhagic or bluish bullae; gas or crepitus; skin necrosis
or extensive ecchymosis
Empiric Treatment of Nonpurulent Cellulitis*/Erysipelas for mild diseas
Cephalexin 500 milligrams PO every 6 h†
Or dicloxacillin 500 milligrams PO every 6 h†
Or clindamycin 150–450 milligrams PO every 6 h†
Empiric Treatment of Nonpurulent Cellulitis*/Erysipelas antibiotics for moderate disease
Ceftriaxone 1 gram IV every 24 h†
Or cefazolin 1 gram every 8 h†
Or clindamycin 600 milligrams IV every 8 h
Empiric Treatment of Nonpurulent Cellulitis*/Erysipelas
for severe disease
Vancomycin 15 milligrams/kg IV every 12 h†
Plus piperacillin-tazobactam, 4.5 grams IV every 6 h†
Or meropenem, 500–1000 milligrams IV every 8 h†
Or imipenem-cilastatin, 500 milligrams IV every 6 h†
Antibiotics Fresh water exposure
Doxycycline 100 milligrams IV every 12 h
Plus ciprofloxacin 500 milligrams IV every 12 h†
Antibiotics Salt water exposure (suspected Vibrio species)
Doxycycline 100 milligrams IV every 12 h†
Plus ceftriaxone 1 gram every 24 h†
Antibiotics Suspected Clostridium species:
Clindamycin 600–900 milligrams IV every 8 h†
Plus penicillin 2–4 million units IV every 4 h†
Type I
polymicrobial
gram-positive cocci, gram-negative rods, and anaerobes
Type II
monomicrobial
group A Streptococcus
type III
Vibrio vulnificus
Type IV
fungal
F our F ungal
“hard” signs of necrotizing fasciitis
Solid:
skin necrosis
Liquid:
bullae,
hypotension, or
Gas:
crepitus
gas on radiograph
True or false
In nec fas, antibiotics alone are rarely effective, and imme-
diate surgical consultation and intervention remain the cornerstone of successful management
True
the gold standard for diagnosis and treatment in necrotizing skin infections
Surgery
Mortality skyrockets if debridement
is delayed
> 24 hours
